Safer D J, Allen R P
Division of Child Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Pediatr. 1989 Dec;115(6):1003-8. doi: 10.1016/s0022-3476(89)80759-0.
To determine whether the behavioral benefits of methylphenidate in hyperactive and inattentive children decline during long-term treatment, we analyzed data from 108 hyperactive students who responded well to methylphenidate therapy for 3 to 10 years. Responders were identified by their consistent improvement from baseline on standard teacher rating scales. The therapeutically effective drug doses were corrected for body size and evaluated in relation to increasing age and treatment duration. Body size corrections included milligrams per kilogram, milligrams per kilogram to the 0.7th power, and milligrams per square meter of estimated body surface area. The major findings were that (1) the dose of methylphenidate, when adjusted for growth, did not change significantly during the 3 to 10 years of treatment; (2) the loss of a previously satisfactory response to methylphenidate treatment was uncommon (6%) and when present was related to middle school enrollment, male gender, noncompliance with medication, and lower than customary dosage; (3) the dose calculations that minimized the effects of growth with age were milligrams per kilogram to the 0.7th power and milligrams per square meter of estimated body surface area; and (4) the commonly used milligrams per kilogram dose consistently overcorrected for growth with advancing age.
为了确定哌甲酯对多动及注意力不集中儿童的行为改善作用在长期治疗过程中是否会减退，我们分析了108名对哌甲酯治疗反应良好、治疗3至10年的多动学生的数据。通过标准教师评定量表中与基线相比的持续改善情况来确定有反应者。根据体型对治疗有效药物剂量进行校正，并根据年龄增长和治疗持续时间进行评估。体型校正包括每千克毫克数、每千克毫克数的0.7次幂以及每平方米估计体表面积的毫克数。主要研究结果为：（1）经生长校正后的哌甲酯剂量在3至10年的治疗期间无显著变化；（2）对哌甲酯治疗先前满意的反应丧失情况不常见（6%），若出现这种情况，则与进入中学、男性性别、不遵医嘱服药以及低于常规剂量有关；（3）能将年龄增长对生长的影响降至最低的剂量计算方法是每千克毫克数的0.7次幂以及每平方米估计体表面积的毫克数；（4）常用的每千克毫克数剂量随着年龄增长对生长的校正始终过度。
